This is a blog by a former CEO of a large Boston hospital to share thoughts about hospitals, medicine, and health care issues.

Monday, February 04, 2008

The ethics of CEO blogging

Last week, the Harvard Medical School Division of Medical Ethics held a session on the ethical issues surrounding blogging by a CEO, particularly the CEO of a health care institution. Local examples were this blog and the one published by Charlie Baker, CEO of Harvard Pilgrim Health Care. Unfortunately, I could not attend, but I received a note from one of the attendees who told me about some issues that had been raised. I'll report on that and add the comments I would likely have made if I had been present.

One of the discussants identified four domains that he thought of as important in thinking about the ethics of a CEO blog, and about which he posed some questions:

1. Voice: Is the CEO blogger blogging as an individual or as the voice of the organization? Charlie's blog is hosted in the HPHC website and linked to HPHC marketing materials. Yours is on Blogger and not linked to the BIDMC site. But when the CEO speaks, what he or she says can't be separated from the organization.

My reply: Whenever I give a speech, or testify before a legislative or regulatory body, or give a media interview, or write an article (for this blog or a journal) people assume that I am speaking from a position of authority and responsibility for the organization. That is just something that cannot be avoided. I do my best to be aware of the institutional consequences of what I say, regardless of the forum.

2. Authenticity: Who is speaking? Is it a real human being speaking, or an avatar created by a ghost writer? Are comments posted as received or are there schills setting up softballs and deletion of tough questions? In other words, is it a real voice and a real discussion?

Reply: I think my readers know that the posts are mine alone. Certainly, the media relations people and lawyers at BIDMC know that! Likewise, the comments are yours alone. I post them all, unless they contain bad language or personal medical information or private personnel information. I keep looking for those softballs, but they are few and far between.

3. Reliance: From a legal perspective, to what extent does CEO blogging create obligations for the organization or claims that outsiders can make?

Reply: See #1 above. Concerning claims, there is little I say on the blog that does not exist in some other form in the hospital (or in my speeches, articles, or elsewhere) and therefore could be used by attorneys as discoverable information in a legal proceeding.

4. Privacy: When Charlie or you draw on communications from patients/members, even if these are de-identified, should consent be asked for from the person(s) involved?

Reply: I ask for consent from patients or their loved ones who write to me. I also de-identify the stories, unless the person involved prefers otherwise. I do not generally ask for consent to use material a staff member sends me about an issue or a process (for example, this one), but I would of course ask permission to print anything related to the personal life of a staff member.

Paul, I have wondered if your attorneys have concerns about your blogging. How involved are they? Do they want to pre-read the blogs? I've never seen any risk in your blogs but in my experience, hospital lawyers are very conservative and risk adverse. How about your PR department? Do you get push back (or kudos) from them?

Neither our attorneys nor our PR people have ever asked to pre-read the blog postings. I think the situation would be quite different if I were CEO of a publicly traded for-profit company with all kinds of SEC disclosure rules. The biggest concern in the hospital environment is HIPAA (patient privacy), and, as mentioned, I request a patient's permission before posting his or her story and then usually de-identify it, also.

In any event, the lawyers and PR folks TELL me that they like what I post . . . but maybe they are just being kind. Don't worry, they are not being deferential: They never hesitate to tell me when I am wrong about anything!

Call me paranoid, but I am curious that Harvard should see fit to hold such a session just when your blog is voted best medical blog (meaning a lot of people see it), and given that you are one of the few health care CEO's who blogs. Was this whole session directed at putting a leash on you? (That's a rhetorical question.) I just find it an interesting coincidence.

Having said that, I was just thinking this morning that there is much misinformation put out there on health-related blogs, certainly NOT this one. Perhaps the session should have been broadened to include that issue.

Although I appreciate the notion of an academic discussion of the ethics of your or Charlie's blog, I can not fathom any legitimate concerns with your content. You have presented an honest and open conversation that lends itself to increased transparency and occasionally enlightened good humor. When house counsel wants to pre-approve content it is time for a new medium.

I wonder why the ethics people would be concerned enough about this topic to put together a session on it. The transparency created by a blogging CEO would seem to be a good thing. And blogging CEOs in health care are exceedingly rare.

If health care CEOs are to be the topic, there are many other examples of CEOs conduct that might raise more ethical concerns than blogging. (For examples, see Health Care Renewal: http://hcrenewal.blogspot.com) In fact, I can think of more examples of health care CEOs convicted of crimes than health care CEOs who blog.

Paul, Your blog shows you embrace leadership as action, not just as a position. For every action there is an equal and opposite reaction. How appropriate, though, your blog continues the ethical debate which questioned the propriety of the blog itself.